A follicular volume of >0.56 cm3 at trigger is the cutoff to predict oocyte maturity: a starting point for novel volume-based triggering criteria.

OBJECTIVE: To determine the minimum follicular volume on the day of trigger that will correspond to a mature oocyte at egg retrieval by individualized follicular puncture and to calculate the mean follicular growth from ovulation induction to egg retrieval using SonoAVCfollicle. DESIGN: A prospective observational study of 53 women undergoing in vitro fertilization, in which it was possible to identify unequivocally one or more follicles at trigger and egg retrieval using three-dimensional ultrasound. SETTING: University-affiliated private in vitro fertilization center. PATIENTS: The final sample included 206 follicles from 14 oocyte donors and 39 patients. INTERVENTIONS: A three-dimensional ultrasound with SonoAVCfollicle was performed at trigger and egg retrieval. The same operator selected follicles that were identified easily on both scans and verified that they were apt to be aspirated individually. Follicles were punctured individually, recording the real aspirated volume and the maturity stage of the oocyte. MAIN OUTCOME MEASURES: The primary outcome was the relationship between follicular volume on the day of the trigger and the oocyte maturity stage. The secondary outcome was the rate of follicular growth from the day of trigger to the day of oocyte retrieval, as measured using SonoAVCfollicle. RESULTS: On the day of trigger 206, follicles were selected. Of these, 5 could not be identified on the day of oocyte retrieval, probably because of follicular rupture (mean volume: 4 cm3, range: 2-7 cm3), and in 48, an oocyte was not obtained. The relationship between follicular volume and oocyte maturity was studied in 153 follicles: 125 (82%) contained mature and 28 (18%) contained immature oocytes. Receiver operating characteristic curves showed an area under the curve value of 0.73 (95% confidence interval: 0.65-0.80). A follicular volume of >0.56 cm3 is the cutoff point, with the highest Youden index having a sensitivity of 85% and a specificity of 64% to predict oocyte maturity. The mean follicular growth from trigger to egg retrieval was 26%-50% in 53% of cases. CONCLUSION: A follicular volume of >0.56 cm3 at trigger is the cutoff point with the optimal balance between sensitivity and specificity for oocyte maturity. Follicles of >2-3 cm3 may undergo spontaneous rupture before egg retrieval. Given these findings, we propose new volume-based criteria for trigger: 70% of follicles of >0.6 cm3 and dominant follicles between 2 and 3 cm3. These findings need validation by randomized controlled trials.

Volume-based follicular output rate improves prediction of the number of mature oocytes: a prospective comparative study.

OBJECTIVE: To test whether volume-based follicular output rate (FORT-V) is superior to diameter based follicular output rate (FORT-D) in predicting the number of mature oocytes. The follicular output rate (FORT) is the ratio between preovulatory follicle count (PFC) and antral follicle count (AFC) and has been proposed as a better predictor of the ovarian response compared with AFC alone. DESIGN: A prospective observational study of 215 consecutive women (80 oocyte donors and 135 in vitro fertilization [IVF] patients) undergoing ovarian stimulation for IVF. SETTING: University affiliated private IVF center. PATIENT(S): Women undergoing ovarian stimulation between May 2018 and September 2021. INTERVENTION(S): Manual two-dimensional ultrasound and computer-generated (three-dimensional ultrasound, [3D]) AFCs were performed at baseline. During ovulation induction, follicular growth was monitored in each patient using both two-dimensional and 3D ultrasound. Preovulatory follicles were defined as those with a mean diameter of 16-22 mm. The trigger was based on the follicular volume according to our standard protocol: at least 2 follicles with a volume of >2 cc with 70% of the follicles having a volume of >0.7 cc. MAIN OUTCOME MEASURE(S): The primary outcome was the difference between FORT-V and FORT-D in their ability to predict the mature oocyte output rate. RESULT(S): In both IVF patients and oocyte donors, the computer-generated AFC was greater than the manual AFC. The FORT-V was higher than the FORT-D for both computer-generated (the difference was 35 [95% CI {confidence interval}, 32-45] in oocyte donors and 21 [95% CI, 5-46] in IVF patients) and manual FORT (the difference was 38 [95% CI, 32-45] in oocyte donors and 15 [95% CI, 3-43] in IVF patients) and was closer to the mature oocyte output rate. There was a direct correlation between the computer-generated AFC and the PFC based on volume and between PFC based on volume and the number of mature oocytes in oocyte donors and IVF patients. CONCLUSION(S): In this prospective study of 215 women, the FORT based on 3D ultrasound derived follicular volume (FORT-V) was superior to the FORT-D in determining the ovarian response in both oocyte donors and IVF patients. Moreover, our results support the non-inferiority of the computer-generated method compared with the manual method for the determination of AFC. Further studies on the role of computer-generated antral follicle characteristics may be useful in evaluating follicle stimulation regimens.

Follicular Volume Predicts Oocyte Maturity: A Prospective Cohort Study Using Three-Dimensional Ultrasound and SonoAVC.

The aim of this study was to investigate whether the automatic measurement of follicular volume by three-dimensional (3D) ultrasound can predict the number of mature oocytes retrieved. A prospective cohort study including 47 women undergoing in vitro fertilization was conducted in a private fertility center. Follicular growth was monitored both manually and automatically using 3D scanning with SonoAVC on the day of human chorionic gonadotropin (hCG) administration. Regression analysis showed that under a standard protocol for hCG administration, the count of mature oocytes is well predicted by a multivariate model including the counts of follicles in the volume classes 2.00 to 5.00 cm3, 1.50 to 1.99 cm3, 1.00 to 1.49 cm3, and 0.60 to 0.99 cm3 In conclusion, this study shows that follicular volume as measured by SonoAVC on the day of hCG administration can be useful to predict oocyte maturity. Specifically, larger follicles and smaller size follicles (class 0.60-0.99 cm3) contribute to the mature oocyte count. This finding warrants the design of clinical trials to establish new criteria for hCG administration based on follicular volume.

Prospective evaluation of automated follicle monitoring in 58 in vitro fertilization cycles: follicular volume as a new indicator of oocyte maturity.

OBJECTIVES: To assess the practical use of SonoAVC in an IVF program, and to establish new criteria for hCG administration based on follicular volume. DESIGN: Prospective clinical study. SETTING: Private IVF Center. PATIENT(S): Fifty-eight women with infertility undergoing IVF. INTERVENTION(S): Two dimensional (2D) and three dimensional (3D) scanning on the day of hCG administration. MAIN OUTCOME MEASURE(S): Image quality, mean follicular diameter obtained by 2D and 3D sonography, follicular volume, number of oocytes retrieved, number of mature oocytes, time needed for each examination. RESULT(S): Approximately 60% of the patients included in this study had good image quality and could be monitored by 3D scans with subsequent application of the SonoAVC software. When image quality is good, measurements obtained by the automated mode are comparable to those obtained manually in 62% of cases. Automated monitoring is significantly quicker than conventional manual monitoring. Follicles with a measured volume >/=0.6 cc on the day of hCG administration are associated with the finding of mature oocytes at the time of egg retrieval. CONCLUSION(S): SonoAVC allows reliable evaluation of stimulated ovaries, and may help us establish new criteria for timing hCG administration based on follicular volume estimation rather than follicular size. Software improvements are needed to improve universal patient use.